Doctors prescribing museum visits

CULTURE/HEALTH/LIFESTYLE

“Yes yes yes, that’s extraordinary,” exclaims Pascaline Bonnave, hopping around with glee after briefly studying a scarlet, poppy-esque drawing with her judicious eyes. “That’s really beautiful. Now you must give a name to it.” She swivels to look at the progress of the other eleven students in her art therapy class. Their task is to invent their own flower as well as to coin a plausible species name. There are tall, yellow florets heavily inspired by sunflowers; exquisite purple, mauve and pink posies; and winding chains of daisy-like blossoms. “It’s not that it’s not beautiful,” adds Bonnave, encouraging one woman who doubts her floral creation. “You just need to finish it. Add some shading. Give it some roots.” The afternoon’s activity, simple as it may seem, is part of a unique initiative drawing on the genuine power of art and culture to improve people’s health and wellbeing.

For more than a decade, the French city of Lille’s Palais des Beaux-Arts — which was inaugurated in 1892 and is home to France’s second largest collection behind only the Louvre — has deployed a kind of “museo-therapy” that uses the museum space and the treasures held within it to help treat patients from local hospitals.

But in September 2023, this initiative became a little more formal when it signed an agreement with the University Hospital Centre of Lille (CHU) to offer 140 museum art therapy sessions over a year to patients who’ve been given a “museum prescription” by doctors, making it one of the most significant programs of its kind in the world.

The idea of a museum prescription — one example of an out-of-hospital, non-clinical treatment known as social prescribing— is that exposure to art and culture or history can complement, accelerate or potentially even displace some forms of medical care in traditional settings and in an effective, enjoyable and low-cost way.

Lille’s Palais des Beaux-Arts has been working with all kinds of people, such as those with Alzheimer’s, drug users and autistic children. Once a week, there’s also an open class for the general public. This day’s session is for women receiving treatment for endometriosis, medically-assisted reproduction and gynecological or breast cancer.

Bonnave begins each two-hour session with a brief tour of the museum’s collection to inspire participants. For this class, she chose a few Realist paintings of flowers and fruits, otherwise known as nature morte, in the museum’s Dutch section. “I know the power of art,” she says. “This place is a gold mine of inspiration.”

Then, participants move to another part of the museum to do an art therapy session.

It all began with sessions for autistic children and grew, in part, from the museum’s need to involve the public in the arts as part of a French obligation for cultural institutions known as the PSC, says Marie Vidal de la Blache, the Palais’s public development manager and lead for art-health projects. “The role of museums isn’t just to present art works,” she notes. “As a museum, we have to be a social actor. We can’t just serve the same people.”

Developing the program took many meetings between city officials and museum figures as well as doctors and hospital representatives in Lille, followed by many years to build the awareness, appreciation and demand for the approach. “It took a while to spread,” adds De la Blache. But now sessions are fully booked.

Lille’s museum prescriptions program held its first session last November and is around half way through its year-long course. Questionnaires are being given to participants before and after sessions, which will later be studied to assess the project’s impact. Nonetheless, says Julia Hotz, author of The Connection Cure, a book exploring the impact of social prescribing projects in 30 countries, there is already an “extremely wide” evidence base for the practice. “There’s a lot of evidence to show that social prescribing improves health outcomes,” she adds. “And there is more and more every year.”

For example, a longitudinal study of 23,660 individuals in the UK participating in choirs, book clubs, amateur theatre and other cultural groups between 2010 and 2015 found that people who were frequently engaged in arts “had lower levels of mental distress and higher levels of mental functioning and life satisfaction”.

Similarly, research spanning more than 90,000 elderly people across 16 countries in 2023 found those with hobbies had fewer depressive symptoms, better health and were more satisfied with their lives. A 25-year study of adults in Copenhagen found those involved in sporting groups had life expectancies up to 10 years longer. Meanwhile, a study of 11,000 adolescents in the US found extracurricular arts activities reduced loneliness and boosted peer support, a lack of which can lead to anti-social or criminal behaviour.

Hotz says there are a broad number of applications for social prescribing. For example, joining sporting and physical activity-oriented clubs can help treat diabetes and other health problems, and museum prescriptions can often help tackle loneliness, anxiety and attention deficit disorders.

That claim is hard to disagree with while within the airy surroundings of the Palais des Beaux-Arts, whose highlights include Édouard Manet’s intimate modernist portraits and Peter Paul Rubens’ grand 17th-century masterpieces. For Bonnave, who has done hundreds of sessions in her career, the benefits are clear to see. “For some participants, you can see that entering the museum is a great honour for them,” she says. “Some begin quiet, but you see they change; grow in confidence.”

One participant, Beatrice, 43, agreed that doing the activities within the museum took the experience to another level. “The space is really moving, the light is beautiful,” she says. “I completely lost my sense of time [during the session].” She added that the museum prescriptions had helped her to deal with burnout. “Normally, I don’t do art at all, I’m not talented like that. But each time, I’ve been very proud of what I did.”

The relatively low cost of social prescriptions and the context of growing strains on health care services in the aftermath of the pandemic are further incentives for institutions to invest in them further, says Hotz. “It reduces the number of times people need to go to the doctor,” she adds.

A report in 2018 by the Royal College of General Practitioners, a professional body for more than 50,000 doctors in the UK, found the majority of doctors said they see one to five patients a day who attended an appointment “mainly because they are lonely” — patients who Hotz says could be treated via social prescribing.

Lille’s program, which will involve an estimated 1,400 participants across the year, required funding of just €21,000 from City Hall — a drop in the ocean of the millions spent every year on healthcare in the city of 236,000 people.

However, the research is still lacking when it comes to quantifying the cost-benefit of social prescriptions, according to Helen Chatterjee, a professor at University College London, who led a team researching museum prescriptions between 2014 and 2017, specifically projects linking lonely older people with partner museums in the UK. “There’s lots of good anecdotal evidence,” she says. “But hardcore health-economics evidence is lacking.”

Yet the arrival of that proof is considered to be only a matter of time, and momentum is quickly growing behind community-led care. In France, the MO.CO. Contemporary Art Museum in Montpellier has an “Art by prescription” scheme, and since January, Lyon’s Claude Bernard University has offered the country’s first college degree in “Cultural Prescriptions”, in conjunction with neurologists, psychologists and arts professionals. Louvre-Lens also recently signed an agreement following in Lille’s footsteps, which will have its funding renewed for at least several years.

“We want to experiment with this approach further,” says Marie-Pierre Bresson, the deputy mayor of Lille, responsible for culture, tourism and decentralised cooperation.

Further afield, the Montreal Museum of Fine Arts has worked with the Francophone Doctors of Canada association since 2018 to offer a form of museum prescriptions, albeit without Lille’s art therapy aspect. In Brussels, Belgium, doctors in one of the city’s largest hospitals have been prescribing museum visits to patients suffering from depression, stress and anxiety since 2022 — and this year that expanded to 18 “medical structures” and 13 museums in the city. Singapore has run an Arts for Healing Program connecting patients with offerings at local music schools and community gardens since 2021. The newly formed advocacy group Social Prescribing USA aims to make social prescribing available to every American by 2035, building on projects already running in Massachusetts and New Jersey.

The great challenge for now, however, is figuring out how to scale up social prescription programs that are inherently most effective when small-scale and highly contextual. “The big Catch-22 is that these initiatives have to be so local and individualised,” says Hotz. But Chatterjee, whose research has looked at how to formalise museum prescriptions, believes progress has been made in the UK, where there is a greater recognition than almost anywhere that many social factors determine someone’s health.

“We are seeing a shift in how institutions are operating from short projects to longer-term core work,” she explains. “The most effective outcomes are achieved when projects are co-designed with participants and when they are sustained over longer, regular periods.”

Fittingly, Chatterjee is now leading a three-year, £25 million project that began in February exploring “how health systems can collaborate more effectively with communities” to tackle health inequalities in poorer parts of the UK. “There’s still very small amounts of money going to [social prescription] providers,” she says. “We’re not throwing enough resources at prevention. But we know that when we do have these collaborations, they can be really fruitful. There’s nothing else like them.”

ABOVE Pascaline Bonnave observing participants during an art therapy session

PHOTO Peter Yeung

Museums take us out of our own head. We get lost in the beauty of something else. It removes us from our anxiety.

Julia Hotz

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